Advantage vs Medigap
Medigap vs. Medicare Advantage: What’s the Difference and Which Is Right for You?
If you’re enrolling in Medicare, you’ve likely heard of both Medigap and Medicare Advantage plans. But what’s the difference—and how do you know which one is the right fit for your needs?
I’m Kristen, a licensed insurance professional with 15 years of experience specializing in the senior market. In this post, I’ll break down the key distinctions between these two types of coverage, highlight the pros and cons of each, and help you understand the most important factors to consider when making your decision.
1. What Is Medigap?
Medigap, also known as Medicare Supplement insurance, is coverage offered by private insurance companies to help pay the out-of-pocket costs that Original Medicare (Parts A and B) doesn’t fully cover—such as copayments, coinsurance, and deductibles. While Medicare provides a strong foundation, it still leaves you with significant financial exposure. A Medigap plan helps reduce that risk by offering more predictable healthcare costs and peace of mind.
To enroll in a Medigap plan, here’s what you need to know:
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You must be enrolled in Original Medicare (Parts A & B)
โ Prescription drug coverage (Part D) is not included—you’ll need a separate standalone plan
๐ฅ No provider networks—see any doctor or specialist nationwide who accepts Medicare
๐ฐ Monthly premiums are required in addition to your Part B premium
๐ซ Does not cover ancillary benefits like dental, vision, or hearing
Medigap plans are standardized by the federal government and identified by letters (e.g., Plan F, G, or N). This means the benefits for each lettered plan are the same regardless of the insurance company offering it. However, monthly premiums can vary based on factors like age, gender, geographic location, and underwriting requirements (including medical history if you're outside your guaranteed issue window).
2. What Is Medicare Advantage?
Medicare Advantage, also known as Part C, is an “all-in-one” alternative to Original Medicare offered by private insurance companies. These plans are required to cover everything included in Parts A and B, and most also bundle in prescription drug coverage (Part D). Many plans go a step further by including additional benefits such as dental, vision, and hearing, along with value-added extras like over-the-counter (OTC) allowances and fitness memberships.
Key Points:
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You must be enrolled in Original Medicare (Parts A & B), though Medicare Advantage replaces your Medicare coverage and becomes your primary insurance
๐ฒ May have lower premiums, with many plans offering $0 monthly premiums (though you still pay your Part B premium)
๐ Uses provider networks—plans are typically structured as HMOs or PPOs
๐ Plans come with defined copays and coinsurance, and each plan includes an annual out-of-pocket maximum
Unlike Medigap, Medicare Advantage plans are not standardized, so benefits, provider access, and costs can vary significantly depending on the insurer, the plan’s service area, and your geographic location. In fact, plan availability and options can differ from county to county, so it’s important to compare plans based on where you live.
3. Medigap vs. Medicare Advantage: What Really Matters
When it comes to Medicare, there’s no one-size-fits-all answer. The “best” plan is different for everyone and should be based on your unique health needs, lifestyle, financial situation, and risk tolerance—not what your neighbor or sister-in-law chose.
Let’s break down the key considerations:
๐งพ Bundled vs. A La Carte Coverage
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Medigap: You'll need to purchase additional coverage for prescription drugs, dental, vision, or hearing separately. Costs for these extras can really add up.
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Medicare Advantage: Offers a more bundled approach, often including drug coverage, dental, vision, hearing, and more—all in one plan.
๐ฅ Provider Networks: Flexibility vs. Structure
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Medigap offers nationwide access to any provider who accepts Medicare—no referrals, no networks. As of 2022, 98% of providers and facilities accepted Medicare.
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Medicare Advantage plans use networks:
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HMO plans require in-network providers and referrals
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PPO plans allow more flexibility for you to see doctors in or out of network without referrals
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Network size varies by location— could be limited in rural areas or robust in populated regions
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๐ฌ Real Talk About Costs
Some Medigap enrollees say, “I never pay anything,” but keep in mind: you’re still paying a monthly premium, even if you don’t use the plan. Those premiums tend to increase with age and over time. With Medicare Advantage, the opposite is true: you may have little or no monthly premium, but higher costs when you need care—especially if your plan has a high maximum out-of-pocket.
4. What to Consider When Choosing a Plan
Choosing between Medigap and Medicare Advantage isn’t just about coverage—it’s about how you want to manage your healthcare and your finances. Consider:
๐ต Your Budget
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Can you afford consistent Medigap premiums every month?
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Or is a lower monthly cost more important?
๐ฉบ Your Health Needs
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Frequent care or chronic conditions? Medigap may offer better peace of mind.
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Relatively healthy? Advantage could provide sufficient coverage with extra perks.
๐ Your Location
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In rural areas, Medigap may offer better access.
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In urban/suburban areas, Advantage plans often have large networks.
๐ Your Lifestyle
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Do you travel often or live in multiple states? Medigap travels with you.
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Advantage plans may be more limited to your home service area but could include travel options
๐จโ๏ธ Your Doctor Preferences
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Want total freedom? Go with Medigap.
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Okay with working within a network? Advantage might suit you.
๐ง Your Simplicity Preference
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Medigap = multiple policies to manage.
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Advantage = streamlined, all-in-one coverage.
5. Need Help Deciding? Let The KP Agency Guide You
Medicare is complex and navigating all the options can be overwhelming. That’s where I come in.
At The KP Agency, I specialize in helping individuals make confident, informed choices about their Medicare coverage. Whether you’re considering a Medigap plan, exploring Medicare Advantage, or just need someone to walk you through the pros and cons—we’re here to make the process easy, personalized, and pressure-free.
Let’s find the right fit for your health, your lifestyle, and your budget.
Reach out today for a free, no-obligation consultation.
๐ Call or text: 908-329-7140
๐ง Email: Kristen@thekpa.net